Pharmacists can save millions by reducing medication-related mishaps among elderly

When pharmacists are part of a patient’s transition from hospital to home, research in Hawaiʻi shows medication-related emergencies decrease among those age 65 and older, saving millions more than the cost of the pharmacists annually.

“CDC researchers have previously estimated that across the US adverse drug events cause nearly 100,000 emergency hospitalizations annually among patients who are 65 and older,” said Karen L. Pellegrin, director of continuing education/strategic planning for the University of Hawaiʻi at Hilo Daniel K. Inouye College of Pharmacy. “We designed and implemented a pharmacist intervention to change those numbers here in Hawaiʻi and the results are in. The medication-related hospitalization rate among older adults decreased by more a third and the estimated annual cost of avoided admissions was over $6 million compared to the cost of the pharmacists, which was less than $2 million.”

Pellegrin is the principal investigator for the Pharm2Pharm program, a $14.3 million federally funded health care innovation designed to give pharmacists a more integrated and proactive role in overseeing high-risk patients’ medication routines. Researchers evaluated the association between the Pharm2Pharm intervention and the costs of medication-related hospitalization among older adults over a period of two years.

Findings are detailed in a research paper appearing this week in the Journal of the American Geriatrics Society, a peer-reviewed source for health care professionals in geriatric medicine and gerontology.

The study examined the pharmacist intervention at six nonfederal, general, acute care hospitals with 50 or more beds in 2013 and 2014, including the four largest hospitals in Hawaiʻi’s three rural counties (Maui, Kauaʻi, Hawaiʻi) and two hospitals in Honolulu County. The other five hospitals on Oʻahu were tracked as a comparison group. Hawaiʻi Health Information Corporation (HHIC), the private nonprofit corporation that maintains the only all-payer hospital database in the state, provided the medication-related admission rate per 1,000 admissions of individuals aged 65 and older by quarter for each hospital from 2010 through 2014.

During the two-year implementation period, more than 2,000 high-risk inpatients were enrolled in Pharm2Pharm at the intervention hospitals. Of those enrolled, 62 percent were aged 65 and older. Based on a statistical model, the rate of medication-related hospitalizations in individuals aged 65 and older was 36 percent lower in the intervention hospitals by the last quarter of 2014 than in the nonintervention hospitals.

This research is important in part, Pellegrin said, because community pharmacists who dispense prescription medications typically have little access to clinical information about the patients, limiting their ability to identify and resolve drug therapy problems.

“Karen put together a program that confirms that pharmacist are underused and underappreciated in our current healthcare system. I applaud her research, management and development skills that helped to show positive outcomes when pharmacists work directly with patients and their doctors outside of the dispensing functions,” said Les Krenk, co-author of the publication, founding officer of the Hawaiʻi Community Pharmacist Association, and owner of the first community pharmacy to participate in the Pharm2Pharm model.

Further research is needed in larger, more-urban hospitals, to determine whether similar results would be achieved.

The paper was authored by Pellegrin, Krenk, Sheena Jolson Oakes, community consulting pharmacist, Maui Clinic Pharmacy, Anita Ciarleglio, assistant specialist, DKICP, Dr. Joanne Lynn, director of the Center for Elder Care and Advanced Illness at Altarum Institute, Dr. Terry McInnis, president and founder, Blue Thorn Inc., Dr. Alistair W. Bairos, general surgeon, Kona Community Hospital, Hawaiʻi Health Systems Corporation, Lara Gomez, director of clinical education, DKICP, Captain Mercedes Benitez McCrary, United States Public Health Service at the Center for Medicare and Medicaid Innovation, Alexandra L. Hanlon, research professor of biostatistics, School of Nursing, University of Pennsylvania, and Jill Miyamura, vice president and COO, Hawaiʻi Health Information Corporation.

The project described is supported by Funding Opportunity CMS-1C1–12–0001 from CMS Center for Medicare and Medicaid Innovation. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human Services or any of its agencies.